Healthcare Provider Details

I. General information

NPI: 1114793205
Provider Name (Legal Business Name): ALFREDO JOSE MARTINEZ RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 GREEN RD STE 200
ANN ARBOR MI
48105-1573
US

IV. Provider business mailing address

192 CONCORD PARK DR
CANTON MI
48187-2589
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-7100
  • Fax:
Mailing address:
  • Phone: 313-320-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number4401007758
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: